Outcomes of elderly patients following thoracoscopic esophagectomy for esophageal cancer

Langenbecks Arch Surg. 2023 Jan 23;408(1):56. doi: 10.1007/s00423-023-02797-5.

Abstract

Purpose: Thoracoscopic esophagectomy (TE) is widely used for esophageal cancer treatment. However, the short- and long-term outcomes of TE in older patients remain unknown. Thus, we investigated those outcomes as well as the effectivity of TE in this patient cohort.

Methods: A total of 228 consecutive patients who underwent TE for esophageal cancer from 2002 to 2015 were included in the study and categorized into the elderly (≥ 75 years) and non-elderly (< 75 years) groups. The background was adjusted by propensity score matching. The short- and long-term outcomes were then compared between the two groups.

Results: There was no difference in the short-term outcomes between the two groups. The elderly group had significantly lower overall survival (OS) and relapse-free survival (RFS) than the non-elderly group. When pulmonary complications occurred, the OS and RFS were significantly decreased in the elderly group but not in the non-elderly group. Without pulmonary complications, the OS and RFS in the elderly group did not differ from those in the non-elderly group. The multivariate analysis showed that pulmonary complications were independent poor prognostic factors for OS and RFS in the elderly group but not in the non-elderly group.

Conclusion: TE is safe and feasible for older patients. However, the OS and RFS of the elderly group were significantly worse than those of the non-elderly group, especially when pulmonary complications occurred. Therefore, perioperative management to prevent pulmonary complications is essential to improve the long-term outcomes of older patients receiving TE.

Keywords: Elderly patient; Esophageal cancer; Minimally invasive esophagectomy; Outcomes; Pulmonary complication.

MeSH terms

  • Aged
  • Esophageal Neoplasms* / surgery
  • Esophagectomy* / adverse effects
  • Humans
  • Middle Aged
  • Multivariate Analysis
  • Postoperative Complications / etiology
  • Propensity Score
  • Retrospective Studies
  • Treatment Outcome